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Electronic Poster Abstracts P1. Pre-Op CT Scan for Distal Radius Fracture Electronic Poster Abstracts P1. Pre-op CT Scan For Distal Radius Fracture: Is It Really Necessary? Jonathan Guevara, MD; Panattoni Joao, MD Saint Louis University, Saint Louis, MO Introduction: Operative treatment of distal radius fractures has gained popularity due to its good outcomes. While preoperative CT scanning theoretically helps preoperative planning, routine use is not standard practice and depends on the surgeon’s preference. The purpose of this study was toevaluate the value of a preoperative CT scan, as determined by postoperative radiographic outcome in patients with a fracture of the distal radius. Materials/Methods: Between May 2013 and December 2014 62 patients with 66 AO/OTA type 23-C fractures were treated with a volar locking plate and had a postoperative CT scan. All patients were available for review. Postoperative radiographic outcome of these fractures was assessed using the postoperative CT scan, evaluating the following radiographic determinants: radial inclination, volar tilt, step-off, intra-articular gap, and assessment of sigmoid notch reduction. Of these 66 fractures, 32 had a preoperative CT scan, and 34 did not. In this way, radiographic outcome for fractures in which a preoperative CT scan had been obtained for operative planning purposes was compared to that of fractures not scanned preoperatively. Results: There was no significant difference between the two groups for any of the radiographic outcome determinants. Those without a preoperative CT scan had acceptable radial inclination (19.7 +/- 4.7mm), volar tilt (10.3 +/- 6.4mm), step-off (0.7 +/- 1.2mm), intra-articular gap (1.7 +/- 2.4mm), and sigmoid notch malreduction (3 of 34 not reduced). In comparison, the fractures having a preoperative CT scan had a radial inclination of 17.1 +/- 6.2mm (p = 0.058), a volar tilt of 10.4 +/- 5.4mm (p = 0.913), a step-off of 1.18 +/- 1.2mm (p = 0.115), an intra-articular gap of 2.1 +/- 1.9mm (p = 0.359), and a sigmoid notch malreduction in 1 of 32 the fractures (Χ2= 0.286) Conclusions: The plain radiographic appearance of fractures of the distal radius often appears complex, possibly directing the treating surgeon to obtain more advanced – and costly – studies, such as a preoperative CT scan. However, our findings indicate that for the AO/OTA type 23-C fracture treated with a volar locking plate, a preoperative CT scan provides no added value. AMERICAN ASSOCIATION FOR HAND SURGERY | 2016 ANNUAL MEETING 1 P2. The Scratch Collapse Test and Evaluation of Patients with Coincident Carpal and Cubital Tunnel Syndrome Justin Koh, BA, MA; Kodi K. Azari, MD, FACS; Prosper Benhaim, MD UCLA, Los Angeles, CA Introduction: Coincident ulnar compression at the cubital tunnel can coexist with carpal tunnel syndrome, but poses a diagnostic challenge - sensitivity of “gold standard” nerve conduction study results is limited to 60-70%. The Scratch Collapse Test is a somewhat controversial provocative diagnostic tool for cubital tunnel syndrome, but given its strong performance in the hands of experienced practitioners, it may be an excellent adjunct for diagnosing coincident ulnar neuropathy at the elbow in carpal tunnel syndrome patients. Methods: This team has previously reported the results of a retrospective analysis of 515 patients to characterize demographics, medical history, physical exam findings, and nerve conduction study results correlated with coincident carpal and cubital tunnel syndromes. This cohort included 96 patients who were also evaluated by the scratch collapse test for ulnar neuropathy at the elbow. This partial cohort was assessed for diagnostic sensitivity of the scratch collapse test. We modified an existing clinical scoring scheme to assess the relative clinical weight of the scratch collapse test. The original scoring scheme evaluated loss of intrinsic hand strength, ulnar sensation loss, positive elbow flexion test, positive cubital tunnel Tinel's sign, and abnormal ulnar nerve conduction study to evaluate risk for coincident compression neuropathy. All modified scoring schemes were assessed by receiver operator characteristics (ROC) curves, as well as by sensitivities, specificities, positive, and negative predictive values. Results: Compared to other physical exam findings specific for cubital tunnel syndrome, the scratch collapse test outperformed all other tests, with a sensitivity of 78.69%. The original scoring model showed an ROC area under the curve (AUC) of 0.9295 with five equally-weighted components. Modified to include the scratch collapse test, this ROC AUC increased to 0.9618 (nearly a perfect predictor of coincident compression). Conclusions: In addition to outperforming other diagnostic factors for evaluating cubital tunnel syndrome, the scratch collapse test significantly improved the holistic diagnostic evaluation of patients with coincident compression neuropathy. In this developmental cohort, a modified clinical score including the scratch collapse test was a robust and efficient method for diagnosing patients at risk for coincident carpal and cubital tunnel syndromes. Figure 1. Comparison of Relative Sensitivities of Physical Exam Findings AMERICAN ASSOCIATION FOR HAND SURGERY | 2016 ANNUAL MEETING 2 Figure 1. Comparison of ROC curves for a.) Conventional score system and b.) Scratch-Collapse modified score system AMERICAN ASSOCIATION FOR HAND SURGERY | 2016 ANNUAL MEETING 3 P3. Variability in Hand Surgery Experience for Graduates of Surgical Specialties Jason Silvestre, BS; Ines I. Lin, MD; L. Scott Levin, MD; Benjamin Chang, MD Perelman School of Medicine, Philadelphia, PA Background: Plastic, orthopedic, and general surgery residents receive unique hand surgery training, yet often compete for similar hand surgery fellowships. The purpose of this study was to determine the baseline hand surgery experience in a national cohort of three specialties. Methods: Procedural statistics for chief residents in 2011-2014 were obtained from the American Council of Graduate Medical Education for plastic, orthopedic, and general surgery residents. Data were grouped by specialty and compared by the number of total hand surgery procedures, including fracture repair, soft tissue reconstruction, and digital amputations. For orthopedic surgery, total number of procedures was calculated by the sum of hand and forearm cases. Statistics for interspecialty comparisons utilized a one way analysis of variance (ANOVA) with a cutoff of p < 0.05 for significance. Results: Over four years, data were available for 640 plastic surgery, 2,687 orthopedic, and 4,355 general surgery residents. From 2011 to 2014, the average number of hand cases reported by plastic surgery residents increased 13.6% from 351.9 to 399.9 cases, and those reported by orthopedic residents decreased 21.7% from 270 to 211.5 cases. A significant difference was observed in the total number of hand cases with plastic surgeons performing the most at 372.3 +/- 192 followed by orthopedic and general surgery at 260.3 +/- 120 and 0.6 +/- 0.1, respectively (p < 0.05). Plastic surgeons performed more soft tissue reconstructions (60.7 vs 45.6) and digital amputations (14.9 vs 6.5) than their orthopedic colleagues (p < 0.05). Orthopedic residents reported more fracture repairs (78.2 vs 44.1, p < 0.05). Conclusions: Experience in hand surgery procedures differs widely among surgical training programs in the United States. These differences may highlight a need for optimization in training for certain areas during hand surgery fellowship. Case volume is a only a proxy for competency and greater research is needed to elucidate baseline proficiencies of incoming hand surgery fellows. AMERICAN ASSOCIATION FOR HAND SURGERY | 2016 ANNUAL MEETING 4 P4. Online Reviews of Hand Surgeons Jason Silvestre, BS; L. Scott Levin, MD Perelman School of Medicine, Philadelphia, PA Background: The online reputation of a practicing hand surgeon is becoming increasingly important. Physician review websites (PRWs) offer patients an opportunity to search their surgeon, but many providers argue these ratings can be misused. The purpose of this study was to evaluate the landscape of online reviews in a national cohort of hand surgeons. Methods: Names of practicing hand surgeons in the 10 most populous American cities were obtained from the search feature of the American Board of Medical Specialties. Gender, age, region, city size, pedigree, and practice type were recorded. A Google search was performed with “[first name] [last name] hand surgeon.” The number of reviews and scaled rating scores (out of 5) were recorded from the three most popular PRWs. A “very poor” rating was defined as a “1/5” review on either Vitals or RateMDs. Data were collected during December 2014 and comparisons were made via Mann-Whitney and Kruskal-Wallis tests. Results: Of 220 hand surgeons, 92.3% had a profile on HealthGrades, 89.6% on Vitals, and 81.9% on RateMDs. The median search result position for academic website was 1, HealthGrades 2, personal website 3, and Vitals 5. Ratings were based on 12.6 +/- 9.1 reviews for HealthGrades, 10.5 +/- 12.5 for Vitals, and 4.1 +/- 5.1 for RateMDs respectively. Out of a maximal score of 5, average scores were 4.1 +/- 0.7 for HealthGrades, 4.3 +/- 0.7 for Vitals, and 4.0 +/- 1.1 for RateMDs. 44.1% of hand surgeons had at least one “very poor” rating on Vitals and 20.8% on RateMDs. No difference was seen in the median number or quality of reviews with regards to gender, age, US region, city size, pedigree (plastic vs ortho trained), or practice type (p > 0.05). Conclusions: Awareness of online reviews may help hand surgeons better manage their online reputation. While mostly positive, a significant number of negative reviews exist. We suggest hand surgeons monitor these sites given their high visibility and potential influence on patients. AMERICAN ASSOCIATION FOR HAND SURGERY | 2016 ANNUAL MEETING 5 P5. Current Trends in Carpal Tunnel Release: A Comparison of Endoscopic and Open Surgical Rates, Outcomes, and Complications between Hand Fellowship and Non-Hand Fellowship Trained Surgeons Utilizing the American Board of Orthopaedic Surgery Certification Exa Brandon S.
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